Can Dual Mobility Cups Reduce Revision and Dislocation Risks? An Analysis of 107,528 Primary Total Hip Arthroplasties in the United States

BACKGROUND

Dual mobility acetabular cups (DMC) were designed to increase the effective femoral head size and improve stability with the goal of reducing revision risk at the potential cost of polyethylene thickness. We sought to evaluate revision risk following primary elective total hip arthroplasty with DMC compared to highly cross-linked polyethylene (XLPE).

METHODS

A cohort study was conducted using data from a Kaiser Permanente's total joint arthroplasty registry. Patients ≥18 years who underwent primary elective total hip arthroplasty using DMC, unipolar Metal-on-XLPE (MoXLPE), or unipolar Ceramic-on-XLPE (CoXLPE) were identified (2010 to 2021). The final sample comprised 2,219 DMC, 48,251 MoXLPE, and 57,058 CoXLPE. Multiple Cox proportional hazard regressions were used to evaluate aseptic revision and any dislocation regardless of revision within 6 years follow-up.

RESULTS

In adjusted analyses, no differences in aseptic revision risk were observed for MoXLPE (hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.72 to 1.51) or CoXLPE (HR = 0.98, 95% CI = 0.69 to 1.40) compared to DMC. No differences in dislocation risk were observed for MoXLPE (HR = 1.42, 95% CI = 0.93 to 2.15) or CoXLPE (HR = 1.25, 95% CI = 0.84 to 1.87) compared to DMC.

CONCLUSIONS

In a US-based cohort, 6-year aseptic revision risk of DMC was similar to metal or ceramic femoral head unipolar constructs. Furthermore, no difference in dislocation risk was observed. Continued longer-term follow-up may reveal if there is a reduced risk of dislocation that comes at the cost of increased late revision.

LEVEL OF EVIDENCE

Level III.

Hyperbaric oxygen effectively addresses the pathophysiology of long COVID: clinical review

Background

The World Health Organization defines long COVID as "the continuation or development of new symptoms 3 months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least 2 months with no other explanation." Estimations of approximately 50 million individuals suffer from long COVID, reporting low health-related quality of life. Patients develop ongoing persistent symptoms that continue for more than 12 weeks that are not explained by another alternative diagnosis. To date, no current therapeutics are effective in treating the underlying pathophysiology of long COVID.

Discussion

A comprehensive literature search using PubMed and Google Scholar was conducted and all available articles from November 2021 to January 2024 containing keywords long covid and hyperbaric oxygen were reviewed. These published studies, including case series and randomized trials, demonstrate that utilizing Hyperbaric Oxygen Therapy (HBO) provided significant improvement in patients with long COVID.

Conclusion

A large cohort of patients suffer from long COVID or post-COVID-19 syndrome after recovery from their acute infection with no effective treatment options. HBO is a safe treatment and may provide benefit for this population and should continue to be researched for adjunctive treatment of long COVID.

Mediating pathways that link adverse childhood experiences with cardiovascular disease

OBJECTIVES

There is uncertainty about which factors mediate the association between adverse childhood experiences (ACEs) and cardiovascular disease (CVD). This could inform secondary prevention targets.

STUDY DESIGN

Mediation analysis of a prospective cohort study.

METHODS

English Longitudinal Study of Ageing (ELSA) wave 3 data (2006/7) were used to measure retrospective exposure to 12 individual ACEs and waves 2 to 4 (2004/5 to 2008/9) data to measure current exposure to potential mediators [smoking, physical activity, alcohol consumption, body mass index, depression, and C-reactive protein (CRP)]. Waves 4 to 9 ELSA data (2008/9 to 2018/19) were used to measure incident CVD. Cumulative ACE exposure was categorised into experiencing 0, 1 to 3, or ≥4 individual ACEs. Associations were tested between ACE categories, potential mediators, and incident CVD, to inform which variables were analysed in causal mediation models.

RESULTS

The analytical cohort consisted of 4547 participants (56% women), with a mean age of 64 years (standard deviation = 9 years). At least one ACE had been experienced by 45% of the cohort, and 24% developed incident CVD over a median follow-up period of 9.7 years (interquartile range: 5.3-11.4 years). After adjusting for potential confounders, experiencing ≥4 ACEs compared with none was associated with incident CVD [odds ratio (OR): 1.55; 95% confidence interval (CI): 1.10, 2.17], and the association of one to three ACEs compared with none was non-significant (OR: 1.08; 95% CI: 0.93, 1.24). There were two statistically significant mediators of the association between ≥4 ACEs and incident CVD: CRP and depression, which accounted for 10.7% and 10.8% of the association, respectively.

CONCLUSIONS

Inflammation and depression partially mediated the association between ACEs and CVD. Targeting these factors may reduce the future incidence of CVD.

Improvements in Quality, Safety and Costs Associated with Use of Implant Registries Within a Health System

BACKGROUND

Clinical quality registries (CQRs) are intended to enhance quality, safety, and cost reduction using real-world data for a self-improving health system. Starting in 2001, Kaiser Permanente established several medical device CQRs as a quality improvement initiative. This report examines the contributions of these CQRs on improvement in health outcomes, changes in clinical practice, and cost-effectiveness over the past 20 years.

METHODS

Eight implant registries were instituted with standardized collection from the electronic health record and other institutional data sources of patient characteristics, medical comorbidities, implant attributes, procedure details, surgical techniques, and outcomes (including complications, revisions, reoperations, hospital readmissions, and other utilization measures). A rigorous quality control system is in place to improve and maintain the quality of data. Data from the Implant Registries form the basis for multiple quality improvement and patient safety initiatives to minimize variation in care, promote clinical best practices, facilitate recalls, perform benchmarking, identify patients at risk, and construct reports about individual surgeons.

RESULTS

Following the inception of the Implant Registries, there was an observed (1) reduction in opioid utilization following orthopedic procedures, (2) reduction in use of bone morphogenic protein during lumbar fusion allowing for cost savings, (3) reduction in allograft for anterior cruciate ligament reconstruction and subsequent decrease in organizationwide revision rates, (4) cost savings through expansion of same-day discharge programs for joint arthroplasty, (5) increase in the use of cement fixation in the hemiarthroplasty treatment of hip fracture, and (6) organizationwide discontinuation of an endograft device associated with a higher risk for adverse outcomes following endovascular aortic aneurysm repair.

CONCLUSION

The use of Implant Registries within our health system, along with clinical leadership and organizational commitment to a learning health system, was associated with improved quality and safety outcomes and reduced costs. The exact mechanisms by which such registries affect health outcomes and costs require further study.

Exploring views of members of the public and policymakers on the acceptability of population level dietary and active-travel policies: a qualitative study

BACKGROUND

There is limited evidence on what shapes the acceptability of population level dietary and active-travel policies in England. This information would be useful in the decision-making process about which policies should be implemented and how to increase their effectiveness and sustainability. To fill this gap, we explored public and policymakers' views about factors that influence public acceptability of dietary and active-travel policies and how to increase public acceptability for these policies.

METHODS

We conducted online, semi-structured interviews with 20 members of the public and 20 policymakers in England. A purposive sampling frame was used to recruit members of the public via a recruitment agency, based on age, sex, socioeconomic status and ethnicity. Policymakers were recruited from existing contacts within our research collaborations and via snowball sampling. We explored different dietary and active-travel policies that varied in their scope and focus. Interviews were transcribed verbatim and analysed using thematic reflexive analysis with both inductive and deductive coding.

RESULTS

We identified four themes that informed public acceptability of dietary and active-travel policies: (1) perceived policy effectiveness, i.e., policies that included believable mechanisms of action, addressed valued co-benefits and barriers to engage in the behaviour; (2) perceived policy fairness, i.e., policies that provided everyone with an opportunity to benefit (mentioned only by the public), equally considered the needs of various population subgroups and rewarded 'healthy' behaviours rather than only penalising 'unhealthy' behaviours; (3) communication of policies, i.e., policies that were visible and had consistent and positive messages from the media (mentioned only by policymakers) and (4) how to improve policy support, with the main suggestion being an integrated strategy addressing multiple aspects of these behaviours, inclusive policies that consider everyone's needs and use of appropriate channels and messages in policy communication.

CONCLUSIONS

Our findings highlight that members' of the public and policymakers' support for dietary and active-travel policies can be shaped by the perceived effectiveness, fairness and communication of policies and provide suggestions on how to improve policy support. This information can inform the design of acceptable policies but can also be used to help communicate existing and future policies to maximise their adoption and sustainability.

A Rare Cause of Headache and an Unorthodox Transfer: A Case Report

INTRODUCTION

Emergency department (ED) crowding and hospital diversion times are increasing nationwide, with negative effects on patient safety and an association with increased mortality. Crowding in referral centers makes transfer of complex or critical patients by rural emergency physicians (EP) more complicated and difficult. We present a case requiring an unorthodox transfer method to navigate extensive hospital diversion and obtain life-saving neurosurgical care.

CASE REPORT

We present the case of a previously healthy 21-year-old male with two hours of headache and rapid neurologic decompensation en route to and at the ED. Computed tomography revealed obstructive hydrocephalus recognized by the EP, who medically managed the increased intracranial pressure (ICP) and began the transfer process for neurosurgical evaluation and management. After refusal by six referral centers in multiple states, all of which were on diversion, the EP initiated an unorthodox transfer procedure to the institution at which he trained, ultimately transferring the patient by air. Bilateral external ventricular drains were placed in the receiving ED, and the patient ultimately underwent neurosurgical resection of an obstructive colloid cyst.

CONCLUSION

First, our case illustrates the difficulties faced by rural EPs when attempting to transfer critical patients when large referral centers are refusing transfers and the need for improvements in facilitating timely transfers of critically ill, time-sensitive patients. Second, EPs should be aware of colloid cysts as a rare but potentially catastrophic cause of rapid neurologic decline due to increased ICP, and the ED management thereof, which we review.

Cause-Specific Stem Revision Risk in Primary Total Hip Arthroplasty Using Cemented vs Cementless Femoral Stem Fixation in a US Cohort

BACKGROUND

We sought to evaluate the cause-specific revision risk following hybrid (cemented stem mated to a cementless acetabular implant) vs cementless total hip arthroplasty (THA) in a US cohort.

METHODS

Primary elective THA for osteoarthritis was identified using Kaiser Permanente's Total Joint Replacement Registry (2001-2018). Multivariable Cox regression was used to evaluate cause-specific revision, including aseptic loosening, infection, instability, and periprosthetic fracture (PPF), for hybrid vs cementless THA. Analysis was stratified by age (<65, 65-74, and ≥75 years) and gender.

RESULTS

The study cohort comprised 88,830 THAs, including 4539 (5.1%) hybrid THAs. In stratified analysis, hybrid THA had a higher revision risk for loosening in females in all 3 age subgroups. A lower risk of revision for PPF was observed following hybrid THA in females aged ≥75 years. For females ≥75 years, cementless THA had an excess PPF risk of 0.9% while hybrid THA had an excess loosening risk of 0.2%, translating to a theoretical prevention of 10 PPF revisions but a price of 3 loosening revisions per 1000 hybrid THAs. No difference in revision risk was observed in males.

CONCLUSION

We observed differences in cause-specific revision risks by method of stem fixation which depended upon patient age and gender. Although the trend toward all cementless fixation continue, there may be a role for hybrid fixation in females ≥75 years to mitigate risk for revision due to PPF at the potential cost of a slight increase in longer term aseptic loosening.

LEVEL OF EVIDENCE

Level III.

How can we achieve impact from public health research? A meta-ethnography of case studies

BACKGROUND

Generation of public health impact from research is challenging. Research of similar quality often has differential uptake and there is considerable lag time between initiation and uptake of research. Improving understanding of how research impact can be achieved may identify areas stakeholders could target.

METHODS

This work uses meta-ethnography to synthesize 21 case studies exploring how researchers have generated public health policy impact.

RESULTS

Eight constructs were identified: expertise; motivation; practical solutions to important problems; support structure and funding; collaboration; wide dissemination and use of media to contribute ideas to the wider narrative; understanding the policy realm; and models of impact. The constructs were combined in a lines-of-argument synthesis, producing a model that seeks to illustrate the diffuse, complex and dynamic nature of the process of generating impact from research.

CONCLUSION

Achieving research impact involves seeking to shape wider debates, building relationships with policy makers, becoming a trusted collaborator and being available to provide relevant and practical solutions to questions of concern to policy makers at the appropriate time.

The relation between the social and the biological and COVID-19

Social factors have been linked to disease severity and mortality in COVID-19. These social factors are ethnicity, social disadvantage, age, gender and occupation. Pre-existing medical conditions have also been identified as an increasing risk. This paper explores the relationship between these social and biological factors using a syndemic frame of reference. The paper argues that although the associations have been very well documented, the mechanisms linking the social factors and disease outcomes are not well understood. An approach that seeks to find commensurability between the social and the biological, is suggested.

Modular Tibial Stem Use and Risk of Revision for Aseptic Loosening in Cemented Primary Total Knee Arthroplasty

BACKGROUND

Modular tibial stem extensions in total knee arthroplasty (TKA) are designed to reduce the risk of aseptic loosening of the tibial base plate. However, these implants add significant cost and an evaluation of their effectiveness in reducing this risk of loosening has not been studied in a large cohort. We sought to evaluate modular tibial stem utilization in primary TKA.

METHODS

We conducted a cohort study using our integrated healthcare system's Total Joint Replacement Registry. Patients who underwent cemented primary TKA were identified (2009-2019). Propensity scores were used to 1:1 match patients without to those with a stem extension. Cox proportional-hazards regression was used to evaluate the risk for revision due to aseptic loosening.

RESULTS

Ten thousand four hundred seventy six TKA with a modular tibial stem were matched to 10,476 TKA without a tibial stem. Stem utilization associated with a lower risk of revision for loosening across all postoperative follow-up (hazard ratio = 0.38, 95% confidence interval = 0.17-0.85).

CONCLUSION

In a matched cohort study, we observed presence of a stem extension was associated with a lower risk of revision for aseptic loosening. Further study to identify specific risk factors for aseptic loosening and confirm the findings presented here are warranted.

LEVEL OF EVIDENCE

Level III.

Commercially Prepared Antibiotic-Loaded Bone Cement and Infection Risk Following Cemented Primary Total Knee Arthroplasty

BACKGROUND

The efficacy of commercially available antibiotic-loaded bone cement (ABC) in preventing infection in total knee arthroplasty (TKA) is unclear. We sought to determine the effectiveness of commercially available ABC in reducing the risk of infection following TKA, both overall and among 3 subgroups of patients with a higher risk of infection (diabetes, body mass index ≥35 kg/m, and American Society of Anesthesiologists classification ≥3), and to evaluate the association between the use of ABC and the risks of aseptic revision and revision for aseptic loosening.

METHODS

The Kaiser Permanente Total Joint Replacement Registry was utilized to evaluate 87,018 primary cemented TKAs performed from 2008 to 2016. The primary outcome was time to infection (90-day deep infection or septic revision). Reduced infection risk with ABC relative to regular cement was tested with use of propensity-score-weighted Cox proportional-hazards models with superiority and noninferiority testing. All analyses were replicated for each of the 3 high-risk subgroups. For the secondary revision outcomes, propensity-score-weighted Cox proportional-hazards models were utilized.

RESULTS

Regular cement was found to be noninferior to ABC with respect to risk infection (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.93 to 1.40) and cost across all TKA patients. However, a lower risk of infection was observed with ABC among TKA patients with diabetes (HR, 0.72; 95% CI, 0.52 to 0.99). There was no evidence of a difference in risk of revision for ABC compared with regular cement.

CONCLUSIONS

We found that the additional cost associated with the use of commercially prepared ABC in primary TKA was not justified in all patients; however, the risk of reduction was lower among patients with diabetes who received ABC. Further study is warranted to identify the efficacy of ABC among other high-risk populations.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evidence-based medicine meets democracy: the role of evidence-based public health guidelines in local government

Background

In 2013, many public health functions transferred from the National Health Service to local government in England. From 2006 NICE had produced public health guidelines based on the principles of evidence-based medicine. This study explores how the guidelines were received in the new environment in local government and related issues raised relating to the use of evidence in local authoritites.

Methods

In depth, interviews with 31 elected members and officers, including Directors of Public Health, from four very different local government organizations (‘local authorities’).

Results

Participants reported that (i) there were tensions between evidence-based, and political decision-making; (ii) there were differences in views about what constituted ‘good’ evidence and (iii) that organizational life is an important mediator in the way evidence is used.

Conclusions

Democratic political decision-making does not necessarily naturally align with decision-making based on evidence from the international scientific literature, and local knowledge and local evidence are very important in the ways that public health decisions are made.

From the National Health Service to local government: perceptions of public health transition in England

OBJECTIVES

In England, in 2013, responsibility for some public health (PH) functions transferred from the National Health Service (NHS) to local government. This moved PH from a health-focussed into a broader and more politically oriented context. This article reports on the perceptions of those involved in this transition about how the PH function was changing as it transited to local government.

STUDY DESIGN

This is a cross-sectional interview study.

METHODS

The study included semi-structured interviews with 31 local government councillors, directors and deputy directors of PH, PH team members and members of clinical commissioning groups. Interviews and data analysis were informed by a theoretical framework, COM-B and an inductive and deductive approach was taken to identify relevant themes.

RESULTS

There was a mixed picture of perceived gains and losses for PH. The transition from NHS to local government was seen by some as a 'homecoming', providing the opportunity for PH to have further reach through influence and collaboration with departments like housing, transport and planning. The opportunity to promote evidence-based practice across local government was also seen as a positive aspect of the transition. However, professional roles of PH and individual PH practitioners were perceived to have less influence and autonomy than in the NHS, with some uncertainty about roles within local government. PH practitioners perceived the need to develop other skills to fulfil their roles in local government. Shorter timescales for action and pressure for faster responses were reported to be the reason for less emphasis on using PH evidence to inform policy and decision-making than hitherto in the NHS.

CONCLUSION

This study illustrates a variety of consequences of transitioning from NHS to local government. There were perceived benefits afforded by proximity to related local government departments but at the costs of reduction in status for PH practitioners and working to a timescale which in some cases reduced drawing on scientific evidence.

Moving beyond individual choice in policies to reduce health inequalities: the integration of dynamic with individual explanations

Background

A strong focus on individual choice and behaviour informs interventions designed to reduce health inequalities in the UK. We review evidence for wider mechanisms from a range of disciplines, demonstrate that they are not yet impacting on programmes, and argue for their systematic inclusion in policy and research.

Methods

We identified potential mechanisms relevant to health inequalities and their amelioration from different disciplines and analysed six policy documents published between 1976 and 2010 using Bacchi's 'What's the problem represented to be?' framework for policy analysis.

Results

We found substantial evidence of supra-individualistic and relational mechanisms relevant to health inequalities from sociology, history, biology, neuroscience, philosophy and psychology. Policy documents sometimes expressed these mechanisms in policy rhetoric but rarely in policy recommendations, which continue to focus on individual behaviour.

Discussion

Current evidence points to the potential of systematically applying broader thinking about causal mechanisms, beyond individual choice and responsibility, to the design, implementation and evaluation of policies to reduce health inequalities. We provide a set of questions designed to enable critique of policy discussions and programmes to ensure that these wider mechanisms are considered.

Reasons for Ninety-Day Emergency Visits and Readmissions After Elective Total Joint Arthroplasty: Results From a US Integrated Healthcare System

BACKGROUND

Previous studies evaluating reasons for 30-day readmissions following total joint arthroplasty (TJA) may underestimate hospital-based utilization of healthcare resources during a patient's episode-of-care. We sought to identify common reasons for 90-day emergency department (ED) visits and hospital readmissions following primary elective unilateral TJA.

METHODS

Patients from July 1, 2012 through June 30, 2015 having primary elective TJA and at least one 90-day postoperative ED-only visit and/or readmission for any reason were identified using the Kaiser Permanente Total Joint Replacement Registry. Chart reviews for ED visits/readmissions included 13 surgical and 11 medical reasons. The 2344 total hips and 5520 total knees were analyzed separately.

RESULTS

Incidence of at least one ED visit following total hip arthroplasty (THA) was 13.4% and 4.5% for readmissions. The most frequent reasons for ED visits were swelling (15.6%) and pain (12.8%); the most frequent reasons for readmissions were infection (12.5%) and unrelated elective procedures (9.0%). The incidence of at least one ED visit following total knee arthroplasty (TKA) was 13.8%, and the incidence of readmission was 5.5%. The most frequent reasons for ED visits were pain (15.8%) and swelling (15.6%); the most common readmission reasons were gastrointestinal (19.1%) and manipulation under anesthesia (9.4%).

CONCLUSION

Swelling and pain related to the procedure were the most frequent reasons for 90-day ED visits after both THA and TKA. Readmissions were most commonly due to infection or unrelated procedures for THA and gastrointestinal or manipulation under anesthesia for TKA. Modifications to discharge protocols may help prevent or alleviate these issues, avoiding unnecessary hospital returns.

PDE11A negatively regulates lithium responsivity

Lithium responsivity in patients with bipolar disorder has been genetically associated with Phosphodiesterase 11A (PDE11A), and lithium decreases PDE11A mRNA in induced pluripotent stem cell-derived hippocampal neurons originating from lithium-responsive patients. PDE11 is an enzyme uniquely enriched in the hippocampus that breaks down cyclic AMP and cyclic GMP. Here we determined whether decreasing PDE11A expression is sufficient to increase lithium responsivity in mice. In dorsal hippocampus and ventral hippocampus (VHIPP), lithium-responsive C57BL/6J and 129S6/SvEvTac mice show decreased PDE11A4 protein expression relative to lithium-unresponsive BALB/cJ mice. In VHIPP, C57BL/6J mice also show differences in PDE11A4 compartmentalization relative to BALB/cJ mice. In contrast, neither PDE2A nor PDE10A expression differ among the strains. The compartment-specific differences in PDE11A4 protein expression are explained by a coding single-nucleotide polymorphism (SNP) at amino acid 499, which falls within the GAF-B homodimerization domain. Relative to the BALB/cJ 499T, the C57BL/6J 499A decreases PDE11A4 homodimerization, which removes PDE11A4 from the membrane. Consistent with the observation that lower PDE11A4 expression correlates with better lithium responsiveness, we found that Pde11a knockout mice (KO) given 0.4% lithium chow for 3+ weeks exhibit greater lithium responsivity relative to wild-type (WT) littermates in tail suspension, an antidepressant-predictive assay, and amphetamine hyperlocomotion, an anti-manic predictive assay. Reduced PDE11A4 expression may represent a lithium-sensitive pathophysiology, because both C57BL/6J and Pde11a KO mice show increased expression of the pro-inflammatory cytokine interleukin-6 (IL-6) relative to BALB/cJ and PDE11A WT mice, respectively. Our finding that PDE11A4 negatively regulates lithium responsivity in mice suggests that the PDE11A SNPs identified in patients may be functionally relevant.

Are Nonagenarians Too Old For Total Hip Arthroplasty? An Evaluation of Morbidity and Mortality Within a Total Joint Replacement Registry

A greater number of patients aged 90 and over will become candidates for total hip arthroplasty (THA) as the nonagenarian population continues to grow. This study evaluated the patient characteristics and incidence of postoperative morbidity and mortality of 183 nonagenarian THA patients among 43,543 primary THA patients followed by a total joint replacement registry. Nonagenarians had a greater number of comorbidities preoperatively, experienced a higher one year mortality and had a longer hospital length of stay. However, nonagenarians did not have an increased risk of infection, deep vein thrombosis or pulmonary embolism and postoperative mortality was within expected rates for individuals 90 years and older. Higher readmission rates, however, highlight the benefits of close follow up during a prolonged postoperative period.

Amphetamine sensitization in mice is sufficient to produce both manic- and depressive-related behaviors as well as changes in the functional connectivity of corticolimbic structures

It has been suggested that amphetamine abuse and withdrawal mimics the diverse nature of bipolar disorder symptomatology in humans. Here, we determined if a single paradigm of amphetamine sensitization would be sufficient to produce both manic- and depressive-related behaviors in mice. CD-1 mice were subcutaneously dosed for 5 days with 1.8 mg/kg d-amphetamine or vehicle. On days 6-31 of withdrawal, amphetamine-sensitized (AS) mice were compared to vehicle-treated (VT) mice on a range of behavioral and biochemical endpoints. AS mice demonstrated reliable mania- and depression-related behaviors from day 7 to day 28 of withdrawal. Relative to VT mice, AS mice exhibited long-lasting mania-like hyperactivity following either an acute 30-min restraint stress or a low-dose 1 mg/kg d-amphetamine challenge, which was attenuated by the mood-stabilizers lithium and quetiapine. In absence of any challenge, AS mice showed anhedonia-like decreases in sucrose preference and depression-like impairments in the off-line consolidation of motor memory, as reflected by the lack of spontaneous improvement across days of training on the rotarod. AS mice also demonstrated a functional impairment in nest building, an ethologically-relevant activity of daily living. Western blot analyses revealed a significant increase in methylation of histone 3 at lysine 9 (H3K9), but not lysine 4 (H3K4), in hippocampus of AS mice relative to VT mice. In situ hybridization for the immediate-early gene activity-regulated cytoskeleton-associated protein (Arc) further revealed heightened activation of corticolimbic structures, decreased functional connectivity between frontal cortex and striatum, and increased functional connectivity between the amygdala and hippocampus of AS mice. The effects of amphetamine sensitization were blunted in C57BL/6J mice relative to CD-1 mice. These results show that a single amphetamine sensitization protocol is sufficient to produce behavioral, functional, and biochemical phenotypes in mice that are relevant to bipolar disorder.

Can total knee arthroplasty be safely performed among nonagenarians? An evaluation of morbidity and mortality within a total joint replacement registry

As the nonagenarian patient population continues to grow, more patients aged 90 and over will become candidates for total knee arthroplasty (TKA). This study evaluated the patient characteristics and incidence of postoperative morbidity and mortality of 216 nonagenarian TKA patients among 81,835 primary TKA patients followed by a total joint replacement registry. Nonagenarians had a greater number of comorbidities preoperatively, experienced a higher rate of deep vein thrombosis and 30 day mortality, and had a longer hospital length of stay. However, nonagenarians did not have an increased risk of infection nor pulmonary embolism and postoperative mortality was within expected rates for individuals 90 years and older. Higher readmission rates, however, highlight the benefits of close follow up during a prolonged postoperative period.

The appraisal of public health interventions: an overview

BACKGROUND

The approach currently used to appraise public health interventions is close to that of health technology appraisal for drugs. This approach is not appropriate for many public health interventions, however, when extremely small individual level benefits are delivered to extremely large populations. In many such situations, randomized controlled trials with sufficient size and power to determine individual level effects are impractical. Such interventions may be cost-effective, even in the absence of traditional evidence to demonstrate this.

METHODS

We outline an alternative approach based on decision theory. We apply it to cases where prior beliefs are sufficiently strong and well grounded to allow decision-makers to assume the direction of change of the intervention's outcome, within the context of a transparent and deliberative decision-making process. Decision theory also assumes that decision-makers are risk neutral, implying that they should make decisions based on an intervention's mean cost-effectiveness, and should therefore disregard variance except when deciding to wait for more information. However, they must allow for biases.

RESULTS

A framework is presented which has the potential to achieve large health gains at no additional cost.

CONCLUSIONS

This analysis provides a rigorous theoretical framework for decision-makers in public health. The implied paradigm shift also applies to some clinically based areas.

Sagittal Bone Saw With Orbital Blade Motion for Improved Cutting Efficiency

Sagittal bone saws are used by orthopedic surgeons for resection of bone; for example in total joint arthroplasty of the hip and knee. In order to prevent damage to surrounding tissue, sagittal saw blades typically oscillate through a small angle, resulting in reduced cutting rates due to short stroke lengths. To improve bone cutting efficiency, sagittal saws oscillate at high speeds, but this creates frictional heating that can harm bone cells. The focus of this research was to design a new sagittal sawing device for improved cutting efficiency. It was hypothesized that the addition of an impulsive thrust force during the cutting stroke would increase cutting rates in cortical bone. A cam-driven device was developed and tested in bovine cortical bone. The impulsive thrust force was achieved by creating a component of blade motion perpendicular to the cutting direction, i.e., orbital blade motion. At the start of each cutting stroke, the mechanism drove the saw blade into the surface of the bone, increasing the thrust force with the intention of increasing the depth of cut per tooth. As each cutting stroke was completed, the blade was retracted from the surface for the purpose of clearing bone chips. The design parameters investigated were cutting stroke length, thrust stroke length, and blade oscillation frequency. A three-factor, two-level design of experiments approach was used to simultaneously test for the effect of design parameters and their interactions on volumetric cutting rate (n = 32). The addition of orbital blade motion to the sagittal saw improved bone cutting rates over traditional oscillatory motion, especially at lower cutting stroke lengths and higher oscillation frequencies (p < 0.05). However, the magnitude of orbital blade motion based on thrust stroke length was limited by a threshold value of approximately 0.10 mm that when exceeded caused the sagittal saw to rebound from the surface of the bone causing erratic cutting conditions. The factor with the greatest positive effect on cutting rate was oscillation frequency. Cutting rates in cortical bone can be improved with the proposed orbital action sagittal saw.

Transcriptional regulation of neurodevelopmental and metabolic pathways by NPAS3

The basic helix-loop-helix PAS (Per, Arnt, Sim) domain transcription factor gene NPAS3 is a replicated genetic risk factor for psychiatric disorders. A knockout (KO) mouse model exhibits behavioral and adult neurogenesis deficits consistent with human illness. To define the location and mechanism of NPAS3 etiopathology, we combined immunofluorescent, transcriptomic and metabonomic approaches. Intense Npas3 immunoreactivity was observed in the hippocampal subgranular zone-the site of adult neurogenesis--but was restricted to maturing, rather than proliferating, neuronal precursor cells. Microarray analysis of a HEK293 cell line over-expressing NPAS3 showed that transcriptional targets varied according to circadian rhythm context and C-terminal deletion. The most highly up-regulated NPAS3 target gene, VGF, encodes secretory peptides with established roles in neurogenesis, depression and schizophrenia. VGF was just one of many NPAS3 target genes also regulated by the SOX family of transcription factors, suggesting an overlap in neurodevelopmental function. The parallel repression of multiple glycolysis genes by NPAS3 reveals a second role in the regulation of glucose metabolism. Comparison of wild-type and Npas3 KO metabolite composition using high-resolution mass spectrometry confirmed these transcriptional findings. KO brain tissue contained significantly altered levels of NAD(+), glycolysis metabolites (such as dihydroxyacetone phosphate and fructose-1,6-bisphosphate), pentose phosphate pathway components and Kreb's cycle intermediates (succinate and α-ketoglutarate). The dual neurodevelopmental and metabolic aspects of NPAS3 activity described here increase our understanding of mental illness etiology, and may provide a mechanism for innate and medication-induced susceptibility to diabetes commonly reported in psychiatric patients.

Synthesizing diverse evidence: the use of primary qualitative data analysis methods and logic models in public health reviews

OBJECTIVES

The nature of public health evidence presents challenges for conventional systematic review processes, with increasing recognition of the need to include a broader range of work including observational studies and qualitative research, yet with methods to combine diverse sources remaining underdeveloped. The objective of this paper is to report the application of a new approach for review of evidence in the public health sphere. The method enables a diverse range of evidence types to be synthesized in order to examine potential relationships between a public health environment and outcomes.

STUDY DESIGN

The study drew on previous work by the National Institute for Health and Clinical Excellence on conceptual frameworks. It applied and further extended this work to the synthesis of evidence relating to one particular public health area: the enhancement of employee mental well-being in the workplace.

METHODS

The approach utilized thematic analysis techniques from primary research, together with conceptual modelling, to explore potential relationships between factors and outcomes.

RESULTS

The method enabled a logic framework to be built from a diverse document set that illustrates how elements and associations between elements may impact on the well-being of employees.

CONCLUSIONS

Whilst recognizing potential criticisms of the approach, it is suggested that logic models can be a useful way of examining the complexity of relationships between factors and outcomes in public health, and of highlighting potential areas for interventions and further research. The use of techniques from primary qualitative research may also be helpful in synthesizing diverse document types.

A conceptual framework for public health: NICE's emerging approach

This paper outlines the National Institute for Health and Clinical Excellence's (NICE) emerging conceptual framework for public health. This is based on the experience of the first 3 years of producing public health guidance at NICE (2005-2008). The framework has been used to shape the revisions to NICE's public health process and methods manuals for use post 2009, and will inform the public health guidance which NICE will produce from April 2009. The framework is based on the precept that both individual and population patterns of disease have causal mechanisms. These are analytically separate. Explanations of individual diseases involve the interaction between biological, social and related phenomena. Explanations of population patterns involve the same interactions, but also additional interactions between a range of other phenomena working in tandem. These are described. The causal pathways therefore involve the social, economic and political determinants of health, as well as psychological and biological factors. Four vectors of causation are identified: population, environmental, organizational and social. The interaction between the vectors and human behaviour are outlined. The bridge between the wider determinants and individual health outcomes is integration of the life course and the lifeworld.

The natural history of osteoarthritic bone cysts after uncemented total hip arthroplasty

This study quantified the radiographic changes of osteoarthritic acetabular bone cysts after uncemented total hip arthroplasty (THA). Ten-year follow-up radiographs from 130 primary THAs were reviewed. Forty-one cysts were identified on immediate postoperative radiographs. Two-dimensional cyst size was measured postoperatively and on long-term radiographs. Mean initial cyst size was 1.0 +/- 0.9 cm(2). Four (10%) of the 41 cysts expanded over time. The average increase in cyst size was 5.1 +/- 8.6 cm(2) which equated to a mean size increase of 713%. Twenty-seven cysts (66%) shrank, and the remaining 10 cysts (24%) did not change with time. Because cysts located in zone II, near the dome hole of the cup, were statistically more likely to progress, we hypothesize that these cysts communicated with the joint space via these holes. We propose that placing the acetabular component to seal an osteoarthritic cyst from the joint space during THA can help prevent its subsequent progression and the risk of associated osteolysis.

Acute near-fatal necrotising fasciitis complicating a primary total hip replacement

Necrotising fasciitis is a rapidly spreading, life-threatening condition. We report a case of necrotising fasciitis in a 71-year-old woman after a primary total hip replacement which became deeply infected as a result.

Measurement of branching fractions and mass spectra of B-->Kpipigamma

We present a measurement of the partial branching fractions and mass spectra of the exclusive radiative penguin processes B-->Kpipigamma in the range m(Kpipi)<1.8 GeV/c(2). We reconstruct four final states: K(+)pi(-)pi(+)gamma, K(+)pi(-)pi(0)gamma, K(S)(0)pi(-)pi(+)gamma, and K(S)(0)pi(+)pi(0)gamma, where K(S)(0)-->pi(+)pi(-). Using 232 x 10(6) e(+)e(-)-->BB events recorded by the BABAR experiment at the SLAC PEP-II asymmetric-energy storage ring, we measure the branching fractions B(B(+)-->K(+)pi(-)pi(+)gamma)=[2.95+/-0.13(stat)+/-0.20(syst)] x 10(-5), B(B(0)-->K(+)pi(-)pi(0)gamma)=[4.07+/-0.22(stat)+/-0.31(syst)] x 10(-5), B(B(0)-->K(0)pi(+)pi(-)gamma)=[1.85+/-0.21(stat)+/-0.12(syst)] x 10(-5), and B(B(+)-->K(0)pi(+)pi(0)gamma)=[4.56+/-0.42(stat)+/-0.31(syst)] x 10(-5).

Measurement of the pseudoscalar decay constant fDs using charm-tagged events in e+e- collisions at square root s=10.58 GeV

Using 230.2 fb-1 of e+e- annihilation data collected with the BABAR detector at and near the peak of the Upsilon(4S) resonance, 489+/-55 events containing the pure leptonic decay Ds+-->micro;+numicro have been isolated in charm-tagged events. The ratio of partial widths Gamma(D+-->micro+numicro)/Gamma(Ds+-->phipi+) is measured to be 0.143+/-0.018+/-0.006 allowing a determination of the pseudoscalar decay constant fDs=(283+/-17+/-7+/-14) MeV. The errors are statistical, systematic, and from the Ds+-->phipi+ branching ratio, respectively.

Observation of decays B0-->Ds(*)+ pi- and B0-->Ds(*)- K+

We report the observation of decays B{0}-->D{s}{(*)+}pi- and B{0}-->D{s}{(*)-}K+ in a sample of 230 x 10(6) Upsilon(4S)-->BB[over] events recorded with the BABAR detector at the SLAC PEP-II asymmetric-energy e+ e- storage ring. We measure the branching fractions B(B{0}-->D{s}{+}pi-)=(1.3+/-0.3(stat)+/-0.2(syst))x10(-5), B(B{0}-->D{s}{-} K+)=(2.5+/-0.4(stat)+/-0.4(syst))x10(-5), B(B{0}-->D{s}{*+}pi-)=(2.8+/-0.6(stat)+/-0.5(syst))x10(-5), and B(B{0}-->D{s}{*-}K+)=(2.0+/-0.5(stat)+/-0.4(syst))x10(-5). The significances of the measurements to differ from zero are 5, 9, 6, and 5 standard deviations, respectively. This is the first observation of B{0}-->D{s}{+}pi-, B{0}-->D{s}{*+}pi-, and B{0}-->D{s}{*-}K+ decays.

Observation of a Charmed Baryon Decaying to D;{0}p at a Mass Near 2.94 GeV/c;{2}

A search for charmed baryons decaying to D(0)p reveals two states: the Lambdac(2880)+ baryon and a previously unobserved state at a mass of [2939.8+/-1.3(stat)+/-1.0(syst)] MeV/c2 and with an intrinsic width of [17.5+/-5.2(stat)+/-5.9(syst)] MeV. Consistent and significant signals are observed for the K(-)pi(+) and K(-)pi(+)pi(-)pi(+) decay modes of the D0 in 287 fb(-1) annihilation data recorded by the BABAR detector at a center-of-mass energy of 10.58 GeV. There is no evidence in the D+p spectrum of doubly charged partners. The mass and intrinsic width of the Lambdac(2880)+ baryon and relative yield of the two baryons are also measured.

Retention of the patella in total knee arthroplasty for rheumatoid arthritis

AIM

To determine whether retention of the native patella during total knee arthroplasty is appropriate in patients with rheumatoid arthritis.

METHODS

All patients undergoing total knee arthroplasty with a diagnosis of rheumatoid arthritis were identified between January 1997 and December 2000. Subsequently, each individual underwent both radiological and clinical assessments at a designated follow-up clinic.

RESULTS

A total of 30 total knee arthroplasties were studied in 28 patients. Twenty-six patients (93%) were female with a mean age of 74.7 years (range 60-83 years). The average post-operative interval was 59.4 months (range 46-82 months). All individuals were noted to have satisfactory patellar tracking and bone stock at the time of surgery. No patient subsequently underwent revision surgery during follow-up and no episodes of implant sepsis were identified. The mean Patellar Score at final follow-up was 26.2 (range 22-30) with an average anterior knee pain score of 14.2 (range 10-15). The mean Oxford Knee Score was 18.7 (range 16-23) with a mean pain score component of 5.9. Patients were finally assessed with respect to the Knee Society Score. The mean Knee Score was 83.8 (range 71-96) with a mean Function Score of 79.7 (range 40-90).

CONCLUSION

By retaining the native patella we were still able to obtain highly satisfactory medium-term results in terms of pain relief and function. In addition, the potential complications associated with prosthetic replacement of the patella were avoided.

Observation of B0 meson decay to a 1 +/(1260)pi /+

We present a measurement of the branching fraction of the decay B(0)-->a1 (+/)(1260)pi(/+) with a1 (+/)(1260)-->pi(/+)pi(+/)pi(+/). The data sample corresponds to 218 x 10(6) BB[over ] pairs produced in e+e- annihilation through the Upsilon(4S) resonance. We measure the branching fraction Beta(B(0)-->a1(+/)(1260)pi(/+))Beta(a1(+/)(1260)-->pi(/+)pi(+/)pi(+/)) = (16.6+/1.9+/1.5) x 10(-6), where the first error quoted is statistical and the second is systematic.

Search for T, CP, and CPT violation in B0-B0 mixing with inclusive dilepton events

We report the results of a search for T, CP, CPT, and violation in B0-B0 mixing using an inclusive dilepton sample collected by the BABAR experiment at the PEP-II factory. Using a sample of 232 x 10(6) BB pairs, we measure the T and CP violation parameter |q/p| - 1 = (-0.8 +/- 2.7(stat) +/- 1.9(syst) x 10(-3), and the CPT and CP parameters Imz = (13.9 +/- 7.3(stat) +/- 3.2(syst)) x 10(-3) and Delta Gamma x Rez = (7.1 +/- 3.9(stat) +/- 2.0(stat)) x 10(-3) ps(-1). The statistical correlation between the measurements of Imz and Delta Gamma x Rez is 76%.

Search for the rare decay B0-->tau+tau- at BABAR

We present the results of a search for the decay B0-->tau+tau- in a data sample of (232+/-3)x10(6) Upsilon(4S)-->BB decays using the BABAR detector. Certain extensions of the standard model predict measurable levels of this otherwise rare decay. We reconstruct fully one neutral B meson and seek evidence for the signal decay in the rest of the event. We find no evidence for signal events and obtain Beta(B0->tau+tau-)<4.1x10(-3) at the 90% confidence level.

Observation of Upsilon(4S) decays to pi(+)pi(-)Upsilon(1S) and pi(+)pi(-)Upsilon(2S)

Observation of Upsilon(4S) decays to pi(+)pi(-)C and pi(+)pi(-)Upsilon(2S)We present the first measurement of Upsilon(4S) decays to pi(+)pi(-)Upsilon(1S) based on a sample of 230 x 106(4S) mesons collected with the BABAR detector. We measure the product branching fractions Beta(Upsilon(4S) --> pi(+)pi(-)Upsilon(1S)) x BetaUpsilon(1S) --> mu(+)mu(-) = (2.23 +/- 0.25(stat) +/- 0.27(syst))x 10(-6) and Beta(Upsilon(4S) --> pi(+)pi(-)Upsilon(2S) x Beta(Upsilon(2S) --> mu(+)mu(-))=(1.69 +/-0.26(stat) +/- 0.20(syst)) x 10(-)6, from which we derive the partial widths Gamma(Upsilon(4S) --> pi(+)pi(-)Upsilon(1S))=(1.8 +/-0.4) keV and Gamma(Upsilon(4S) --> pi(+)pi(-)Upsilon(2S))=(2.7 +/- 0.8) keV.

Determinations of from inclusive semileptonic decays with reduced model dependence

We report two novel determinations of /|Vub/ with reduced model dependence, based on measurements of the mass distribution of the hadronic system in semileptonic B decays. Events are selected by fully reconstructing the decay of one B meson and identifying a charged lepton from the decay of the other B meson from Upsilon(4S)-->BB events. In one approach, we combine the inclusive B-->Xulambdav rate, integrated up to a maximum hadronic mass mX<1.67 GeV/c2, with a measurement of the inclusive B-->Xsgamma photon energy spectrum. We obtain /Vub/=(4.43+/-0.38stat+/-0.25syst+/-0.29theo) x 10-3. In another approach we measure the total B-->Xulambdav rate over the full phase space and find /Vub/=(3.84+/-0.70stat+/-0.30syst+/-0.10theo) x 10-3.

Measurements of the absolute branching fractions of B+/- --> K+/-X(cc)

We study the two-body decays of B+/- mesons to K+/- and a charmonium state X(cc) in a sample of 210.5 fb(-1) of data from the BABAR experiment. We perform measurements of absolute branching fractions beta(B+/- --> K+/-X(cc)) using a missing mass technique, and report several new or improved results. In particular, the upper limit beta(B+/- --> K+/- X(3872)) < 3.2 x 10(-4) at 90% C.L. and the inferred lower limit beta(X(3872)J/psipi+ pi-) > 4.2% will help in understanding the nature of the recently discovered X(3872).

Search for lepton flavor violation in the decay tau+/--->e+/-gamma

A search for the nonconservation of lepton flavor in the decay tau+/--->e+/-gamma has been performed with 2.07x10(8) e+e--->tau+tau- events collected by the BABAR detector at the SLAC PEP II storage ring at a center-of-mass energy near 10.58 GeV. We find no evidence for a signal and set an upper limit on the branching ratio of Beta(tau+/--->e+/-gamma)<1.1x10(-7) at 90% confidence level.

Measurement of branching fractions and resonance contributions for B0 --> D0K+pi- and search for B0 --> D0K+pi- decays

Using 226 x 10(6) gamma(4S) --> BB events collected with the BABAR detector at the PEP-II e+e- storage ring at the Stanford Linear Accelerator Center, we measure the branching fraction for B0 --> D0K+pi-, excluding B0 --> D*-K+, to be beta(B0 --> D0K+pi-) = (88 +/- 15 +/- 9) x 10(-6). We observe B0 --> D0K*(892)0 and B0 --> D2*(2460)-K+ contributions. The ratio of branching fractions beta(B0 --> D*-K+)/beta(B0 --> D*-pi+) = (7.76 +/- 0.34+/-0.29)% is measured separately. The branching fraction for the suppressed mode B0 --> D0K+pi- is beta(B0 --> D0K+pi-) < 19 x 10(-6) at the 90% confidence level.

Evidence for B+ --> K0K+ and B0 --> K0K0, and measurement of the branching fraction and search for direct CP violation in B+ --> K0pi+

We present evidence for the b --> d penguin-dominated decays B+ --> K0K+ and B0 --> K0K0 in 227 x 10(6) Y(4S) --> BB decays collected with the BABAR detector. We measure the branching fractions B(B+ --> K0K+) = (1.5 +/- 0.5 +/- 0.1) x 10(-6)(< 2.4 x 10(-6)) and B(B0 --> K0K0) = [formula: see text], where the uncertainties are statistical and systematic, respectively. We also present improved measurements of the charge-averaged branching fraction B(B+ --> K0pi+) = (26.0 +/- 1.3 +/- 1.0) x 10(-6) and CP-violating charge asymmetry A(CP) (K0pi+) = -0.09 +/- 0.05 +/- 0.01), where the uncertainties are statistical and systematic, respectively.

Search for lepton-flavor and lepton-number violation in the decay tau(-) -->l-(+)h+(-)h'(-)

A search for lepton-flavor and lepton-number violation in the decay of the tau lepton into one charged lepton and two charged hadrons is performed using 221.4 fb(-1) of data collected at an e+e- center-of-mass energy of 10.58 GeV with the BABAR detector at the SLAC PEP-II storage ring. In all 14 decay modes considered, the observed data are compatible with background expectations, and upper limits are set in the range B(tau-->lhh')<(0.7 - 4.8) x 10(-7) at 90% confidence level.

Measurements of branching fractions and Dalitz distributions for B0 --> D(*)+/-K0pi-/+ decays

We present measurements of the branching fractions for the three-body decays B0 --> D(*)-/+K0pi+/- and their resonant submodes B0 --> D(*)-/+K*+/-using a sample of approximately 88 x 10(6) BB pairs collected by the BABAR detector at the SLAC PEP-II asymmetric energy storage ring. We measure: B(B0 --> D-/+K0pi+/-) = (4.9 +/- 0.7stat +/- 0.5syst) x 10(-4), B(B0 --> D*-/+K0pi+/-) = (3.0 +/- 0.7stat +/- 0.3syst) x 10(-4), B(B0 --> D-/+K*+/-) = (4.6 +/- 0.6stat +/- 0.5syst) x 10(-4), B(B0 --> D*-/+K*+/-) = (3.2 +/- 0.6stat +/- 0.3syst) x 10(-4). From these measurements we determine the fractions of resonant events to be f(B0 --> D-/+K*+/-) = 0.63 +/- 0.08stat +/- 0.04syst and f(B0 --> D*-/+K*+/-) = 0.72 +/- 0.14stat +/-0.05syst.

Measurement of time-dependent CP asymmetries and the CP-odd fraction in the decay B0-->D*+D*-

We present an updated measurement of time-dependent CP asymmetries and the CP-odd fraction in the decay B0-->D*+D*- using 232x10(6)BB pairs collected by the BABAR detector at the SLAC PEP-II B factory. We determine the CP-odd fraction to be 0.125+/-0.044(stat)+/-0.007(syst). The time-dependent CP asymmetry parameters C+ and S+ are determined to be 0.06+/-0.17(stat)+/-0.03(syst) and -0.75+/-0.25(stat)+/-0.03(syst), respectively. The standard model predicts these parameters to be 0 and -sin2beta, respectively, in the absence of penguin amplitude contributions.

Improved measurements of CP-violating asymmetry amplitudes in B0-->pi+pi- decays

We present updated measurements of the CP-violating parameters Spipi and Cpipi in B0-->pi+pi- decays. Using a sample of 227x10(6) Upsilon(4S)-->BB decays collected with the BABAR detector at the PEP-II asymmetric-energy e(+)e(-) collider at SLAC, we observe 467+/-33 signal decays and measure Spipi=-0.30+/-0.17(stat)+/-0.03(syst) and Cpipi=-0.09+/-0.15(stat)+/-0.04(syst).

Production and decay of xi(c)(0) at BABAR

Using 116.1 fb(-1) of data collected by the BABAR detector, we present an analysis of xi(c)(0) production in B decays and from the cc continuum, with the xi(c)(0) decaying into omega- K+ and xi- pi+ final states. We measure the ratio of branching fractions B(xi(c)(0) --> omega- K+)/B(xi(c)(0) --> xi- pi+) spectrum is measured on and 40 MeV below the upsilon(4S) resonance. From these spectra the branching fraction product B(B --> xi(c)(0)X) x B(xi(c)(0) --> xi- pi+) is measured to be (2.11 +/- 0.19 +/- 0.25) x 10(-4), and the cross-section product sigma(e+ e- --> xi(c)(0)X) x B(xi(c)(0) --> xi- pi+) from the continuum is measured to be (388 +/- 39 +/- 41) fb at a center-of-mass energy of 10.58 GeV.

Observation of a broad structure in the pi+ pi- J/psi mass spectrum around 4.26 GeV/c2

We study initial-state radiation events, e+ e- --> gammaISR pi+ pi- J/psi, with data collected with the BABAR detector. We observe an accumulation of events near 4.26 GeV/c2 in the invariant-mass spectrum of pi+ pi- J/psi. Fits to the mass spectrum indicate that a broad resonance with a mass of about 4.26 GeV/c2 is required to describe the observed structure. The presence of additional narrow resonances cannot be excluded. The fitted width of the broad resonance is 50 to 90 MeV/c2, depending on the fit hypothesis.

Measurement of branching fractions and charge asymmetries in B+ decays to eta pi+, eta K+, eta rho+, and eta' pi+, and search for B0 decays to eta K0 and eta omega

We present measurements of branching fractions and charge asymmetries for six B-meson decay modes with an eta or eta(') meson in the final state. The data sample corresponds to 232 x 10(6) BB pairs collected with the BABAR detector at the PEP-II asymmetric-energy e(+)e(-) B Factory at SLAC. We measure the branching fractions (in units of 10(-6)): B(B+ -->eta pi(+))=5.1+/-0.6+/-0.3, B(B+ etaK+)=3.3+/-0.6+/-0.3, B(B0-->etaK0)=1.5+/-0.7+/-0.1 (<2.5 at 90% C.L.), B(B+-->eta rho(+))=8.4+/-1.9+/-1.1, B(B0-->eta omiga)=1.0+/-0.5+/-0.2 (<1.9 at 90% C.L.), and B(B+-->eta(')pi(+))=4.0+/-0.8+/-0.4, where the first uncertainty is statistical and second systematic. For the charged modes we also determine the charge asymmetries, all found to be compatible with zero.

Measurement of time-dependent CP asymmetries in B0-->D(*)+/-D+/- decays

We present a first measurement of CP asymmetries in neutral B decays to D+D-, and updated CP asymmetry measurements in decays to D(*+)D- and D(*-)D+. We use fully reconstructed decays collected in a data sample of (232+/-3) x 10(6) gamma(4S)-->BB events in the BABAR detector at the PEP-II asymmetric-energy B Factory at SLAC. We determine the time-dependent asymmetry parameters to be SD(*+)(D-)=-0.54+/-0.35+/-0.07, CD(*+)(D-)=0.09+/-0.25+/-0.06, SD(*-)(D+)=-0.29+/-0.33+/-0.07, CD(*-)(D+)=0.17+/-0.24+/-0.04, SD+(D-)=-0.29+/-0.63+/-0.06, and CD+(D-)=0.11+/-0.35+/-0.06, where in each case the first error is statistical and the second error is systematic.